NPIMap

Individual provider Active NPI

Thomas L Johnson Jr., MD

  • Urology Physician
  • Los Angeles, CA
National Provider Identifier
1881765584
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
C41044 Issued in CA
Practice address
9100 S Sepulveda Blvd Ste 121
Los Angeles, CA 90045-4849
Phone
(310) 674-6785
Fax
(310) 674-2161
NPI assigned
Nov 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X C41044 CA Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

9100 S Sepulveda Blvd Ste 121
Los Angeles, CA 90045-4849

Mailing address

9100 S Sepulveda Blvd Ste 121
Los Angeles, CA 90045-4849
Phone (310) 674-6785

Other identifiers 1

IdentifierTypeStateIssuer
00C410441MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091110000577 CA Practitioner - Urology 6507904695 Practice locations: Los Angeles, CA

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of North Carolina at Chapel Hill School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9100 S Sepulveda Blvd
Suite 121
Los Angeles, CA 90045-4849
Phone (310) 674-6785

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
87.6
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C41044CAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brotman Medical Center, Inc. Past Accepting new patients
Southern California Healthcare System, Inc Past Accepting new patients
Prime Healthcare Centinela, LLC Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1881765584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9100 S SEPULVEDA BLVD STE 121",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900454849",
            "telephone_number": "310-674-6785",
            "fax_number": "310-674-2161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9100 S SEPULVEDA BLVD STE 121",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900454849",
            "telephone_number": "310-674-6785",
            "fax_number": "310-674-2161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "THOMAS",
        "middle_name": "L",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "C41044",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C410441",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.